Provider Demographics
NPI:1598212870
Name:THOMAS, SAMYNTHIA WILLIBY
Entity Type:Individual
Prefix:MRS
First Name:SAMYNTHIA
Middle Name:WILLIBY
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4958 FRIAR TUCK DR
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70128-3005
Mailing Address - Country:US
Mailing Address - Phone:504-351-9919
Mailing Address - Fax:
Practice Address - Street 1:4958 FRIAR TUCK DR
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70128-3005
Practice Address - Country:US
Practice Address - Phone:504-351-9919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-05
Last Update Date:2016-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA600846883Medicaid